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专业护理临床实用指导:母乳喂养指导手册

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《专业护理临床实用指导:母乳喂养指导手册》是“专科护理临床实用指导”系列丛书之一,是一本由中华护理学会第25届妇产科护理专业委员会组织全国妇产科护理专家编写的实用性很强的辅助教材。
母乳喂养关系到母婴的健康,是产科护理的重要工作之一。我国现有7000多所爱婴医院(目的是保护、支持、促进母乳喂养)。产科的医护人员很需要母乳喂养方面的专业知识指导,但是目前国内此类指导书还很少。
参加《专业护理临床实用指导:母乳喂养指导手册》编写工作的专家均来自临床一线,有着多年丰富的母乳喂养指导和教学经验,其中部分专家还参加过世界卫生组织的培训。
Content Description

《专业护理临床实用指导:母乳喂养指导手册》详细介绍了爱婴医院和母乳喂养的相关政策、母乳喂养的重要性、母乳喂养技巧、特殊情况下的母乳喂养及有关母乳喂养常见问题的解答。内容科学,图文并茂,不仅可为临床护士提供切实可行的指导,对于不断提高我国纯母乳喂养率、促进儿童健康成长也有十分重要的意义。
Author Description

王立新,中华护理学会妇产科专业委员会主任委员、北京护理学会妇产科专业委员会副主任委员、中华护理杂志编委、中华现代护理杂志编委。
Catalogue

第一章 爱婴医院和母乳喂养的相关政策
第一节 概述
第二节 爱婴医院和《促进母乳喂养成功的十项措施》
第三节 中国《爱婴医院管理监督指南》
第四节 WHO《促进母乳喂养成功的十项措施》的解读和循证学依据

第二章 母乳喂养的重要性
第一节 母乳喂养的定义
第二节 母乳喂养的重要性
第三节 母乳喂养的好处
第四节 人工喂养的缺点

第三章 乳汁的产生和分泌
第一节 乳房的结构和发育
第二节 乳汁的分泌
第三节 母乳的成分

第四章 母乳喂养技巧
第一节 母乳喂养的体位
第二节 托起乳房的正确方法
第三节 含接姿势
第四节 加奶适应证和正确方法

第五章 母乳喂养的评估
第一节 评估母乳喂养
第二节 母乳喂养观察表

第六章 母乳喂养中的常见问题及处理流程
第一节 乳头扁平与凹陷
第二节 乳头过长或过大
第三节 乳汁分泌不足
第四节 乳房肿胀
第五节 乳腺管阻塞和乳腺炎
第六节 乳腺脓肿
第七节 乳头疼痛和乳头皲裂
第八节 假丝酵母菌感染
第九节 婴儿舌系带短
第十节 其他问题

第七章 挤奶和乳汁保存
第一节 正确的挤奶方法
第二节 吸乳器吸乳
第三节 母乳的保存
第四节 母乳的加热及消毒方法

第八章 特殊情况下的母乳喂养
第一节 常见新生儿的母乳喂养问题
第二节 妊娠并发症
第三节 哺乳期母亲的用药
第四节 母亲感染
第五节 母亲患传染病
第六节 人类免疫缺陷病毒(HIV)的母乳喂养问题
第七节 上班后的母乳喂养
第八节 6个月之后的辅食添加

第九章 母乳喂养支持系统
第一节 孕妇学校母乳喂养管理
第二节 泌乳顾问
第三节 母乳喂养门诊

第十章 母乳喂养常见问题解答

附录
附录1 母乳喂养常用词汇中英对照
附录2 母乳喂养临床干预指南(草案)
附录3 常见母乳喂养问题的解决方法汇总
参考文献
Book Abstract

第六章 母乳喂养中的常见问题及处理流程
母乳喂养中常见的乳房问题有:乳头扁平或凹陷、过长或过大的乳头、乳汁分泌不足乳房肿胀、乳腺管阻塞和乳腺炎、乳头疼痛和乳头皲裂等;新生儿问题有:含接姿势不良、鹅口疮、舌系带短、乳头错觉等。
第一节 乳头扁平与凹陷
一、概述
有些孕产妇经常因为自己乳房或者乳头形状而担心分娩后母乳喂养不能顺利进行。需要强调的是,不同形状和大小的乳房都是正常的,任何形状的乳头都不会影响泌乳,都可以为婴儿提供充足的乳汁(图6-1)。
(一)乳房伸展性检查
指导母亲洗净手,用手牵拉乳晕组织,检查乳房的伸展性,如果牵拉乳头下的组织是很容易的,说明乳房的伸展性很好,婴儿很容易牵拉并在嘴中形成“奶嘴”,婴儿可以比较容易地含住乳头。
(二)乳头凹陷的分级
乳头凹陷可以分为真性凹陷和假性凹陷,即检查其乳房伸展性时,一部分乳头凹陷用手牵拉刺激时乳头能够突出于乳房外,这种凹陷称假性凹陷。另一部分凹陷的乳头通过牵拉刺激仍不能纠正,称为真性凹陷。
Hans等根据乳头凹陷的程度和干预措施,将凹陷分为三级1:
(1)一度:为部分乳头内陷,能轻易被挤出,挤出后乳头能够保持突出状态。
(2)二度:乳头完全凹陷于乳晕之中,但可用手挤出乳头,难以维持突出状态。
(3)三度:为乳头完全埋在乳晕下方,无法使内陷乳头挤出。
(三)乳头扁平凹陷对母乳喂养的影响
母亲的乳房大小不同、乳头情况不同,但一般都不会影响泌乳。但母亲乳头扁平时,可能会认为婴儿不能很好地在乳房上吸吮,这是与婴儿在奶瓶上吸吮时相比而得出的结论。其实,婴儿在母亲乳房上吸吮,必须将乳头和大部分乳晕含在口中,舌头呈勺状,包绕到乳晕上,婴儿不是只吸吮乳头,而是将乳头和乳晕下面的乳房组织含进嘴里形成一个“长奶嘴”,乳头仅占此“奶嘴”的1/3,因此,在乳房上吸吮,乳头的长短就不那么重要了,重要的是乳晕组织的伸展性好不好。
二、扁平和凹陷乳头的处理措施
1.妊娠期
要点:要让母亲知道,乳房的伸展性比乳头的形状更为重要。孕妇有乳头扁平或凹陷时,在妊娠期给予母亲干预可能没有帮助。在妊娠中期至妊娠晚期37周未足月前,不主张刺激乳头、做乳头十字操或牵拉乳头。可在妊娠37周后再干预扁平或凹陷的乳头,以免诱发宫缩,甚至引起早产的可能。
乳房的伸展性在妊娠期或在婴儿出生后约1周内会逐步改善。所以即使在妊娠早期,母亲的乳头看上去是扁平的,她也不必过分担心,通常在妊娠晚期和分娩后自然会得到改善,她的婴儿出生后仍然可以毫不费力地含接住乳房。
严重的乳头凹陷最好在妊娠前纠正,可咨询母乳喂养师,使用相应的乳头矫正器等器材进行矫正。详细方法见后。
2.产后
通常在分娩后即刻让母亲与婴儿皮肤接触,尽快早开奶,可以树立母亲的信心,乳房的问题将有所改善。医务人员应向母亲解释婴儿哺乳时吸吮的是乳晕和乳头而不只是乳头。尽早帮助和指导母亲使用正确的哺乳体位以及试行不同的哺乳体位,包括环抱式。帮她将乳头立起得更好些,用泵或空针筒牵拉乳头。必要时在产后1~2周内挤奶和用杯子喂,或挤奶直接滴到婴儿的嘴里,使婴儿不至于太灰心。医护人员需要树立母亲的信心,并给予必要的帮助和指导。
(1)向母亲解释开始时可能有困难,但只要耐心和坚持,她就能成功。要将婴儿频繁地放在乳房上,只要婴儿感兴趣他会在乳房上尝试,掌握吸吮到乳房的技巧。向母亲解释她的乳房会改善,并在产后l~2周变软。婴儿的吸吮将有助于她的乳头向外拉出,乳头扁平或凹陷将得到纠正。
(2)向母亲解释婴儿需要的是含入大部分的乳晕。解释当婴儿吸吮时,他会把乳房乳头整个向外拉。
(3)鼓励母亲进行足够的对皮肤的早接触,并且让婴儿寻找乳房。无论何时只要婴儿有兴趣,让他自己试着去含接乳房,有些婴儿很快就能掌握在乳房上含接的技巧。
(4)帮助母亲掌握正确的哺乳姿势。
如果婴儿自己不能很好地含接,就应帮助母亲将婴儿放好,以便他能正确含接。要尽早给予这种帮助,可在分娩后的第一天,尚未“下奶”且乳房尚未充盈之前,这时因乳房比较松软,婴儿容易含接住乳房。
(5)帮助母亲尝试不同的母乳喂养体位,如坐位、侧卧位、环抱式。
婴儿在乳房含接困难时,有时用不同的方式抱好婴儿,使他容易含接。例如,有些母亲认为环抱式最好(图6-3),这种体位母亲比较省力(婴儿体重没有完全在母亲手臂上),能清楚地看到婴儿的嘴含接乳房,婴儿更容易将乳头和大部分乳晕含在口中。
(6)喂奶前帮助乳头突起,用手牵拉或刺激乳头使乳头立起,或用吸奶器或空针筒将乳头吸出,方便婴儿含接。有时母亲用手将乳房塑性成一定形状,使婴儿易于含接。为了将乳房成形,母亲用她的手指从下面托起乳房,并用拇指轻轻压在乳房上部,但母亲的手指不要太靠近乳头,因为手指太靠近乳头时妨碍婴儿含接乳房(图6-4)。
(7)如果婴儿在最初1~2周不能做到有效吸吮,帮助母亲做以下几点:
a)挤出母亲乳汁,用小杯子、小勺喂婴儿。
乳房肿胀时,挤奶有助于乳房柔软,这样使婴儿容易含接到大部分乳晕,并帮助维持乳汁产生。
母亲不应使用奶瓶,因为这样会使婴儿吃她的奶时更为困难,这就是通常所说的婴儿“乳头错觉”。“乳头错觉”的产生是由于在婴儿掌握在母亲乳房上如何正确的含接之前,给婴儿使用了橡皮奶嘴,橡皮奶嘴与母亲的乳头相比,乳头长、较硬、乳孔大,使用时奶瓶中大多装的是配方奶或水,婴儿很容易得到里面的食物或水,再到母亲乳房上吸吮时婴儿会进行比较,这时在母亲乳房吸吮时相对费劲,再加上配方奶粉的味道与母乳的味道不同,婴儿不愿意吸吮母亲乳房,或婴儿习惯于吸吮橡皮奶嘴,在母亲乳房上容易导致乳头吸吮——无效吸吮。
b)直接挤少量乳汁到婴儿口中。
有些母亲发现这方法有用,婴儿直接得到一些乳汁,这样婴儿就不会太灰心,他可能更愿意试着去吸吮乳房。
c)使婴儿频繁地接触母亲的乳房。
母亲应不断地与婴儿进行皮肤与皮肤的接触,使婴儿不饿的时候就开始试着含接她的乳房。
乳头矫正器械的制作和使用
(1)单针筒乳头简易牵拉器的制作(图6-5):准备一副10ml的塑料注射器,将注射器前端的外壳剪掉;拔出针芯,倒转注射器,将注射器的外壳后端开口处对准凹陷的乳头;再将针芯从注射器前端剪开处插入,轻轻抽吸,利用注射器的负压将凹陷的乳头吸出,并固定5~6分钟;每天1~2次。(2)双针筒:取5ml和20ml清洁玻璃针管各1支,两针管针头插座由10~15cm输液塑料管连接,去掉5ml针管的针栓。为防漏气,该针筒口蘸水后倒扣于内陷的乳头上,然后抽吸20ml针管,可见内陷的乳头向5ml针管内伸凸。每侧乳房可做8~10分钟,每日早晚各1次。(3)乳头矫正器(图6-6):市场上有各种乳头矫正器出售,产妇可以根据需要选购。这些矫正器一般由硬塑料保护罩和硅胶软垫组成,佩戴在文胸内。硅胶软垫压迫乳晕,帮助乳头突出,这是一种非手术的物理矫正方式,对乳头的刺激较小,不易引起宫缩等问题。
三、乳头扁平凹陷的处理流程
1.分娩后尽快早接触、早吸吮、早开奶。
2.剖宫产母亲回室后,责任护士应尽快帮助母亲完成与婴儿的皮肤接触。
3.由于部分婴儿可能在乳房上含接困难,应告诉母亲多让婴儿靠近乳房,只要婴儿感兴趣他就会尝试含接乳房。
4.指导妈妈母乳喂养的技巧,如乳房塑形、哺乳姿势等。
5.有指征为婴儿加奶时,不要使用奶瓶加奶。
6.使用乳盾时应慎重,并教母亲使用的要点。婴儿能在乳房上含接时,应及时撤下乳盾。
乳头扁平凹陷处理流程可参考图6-7。
……
Introduction

《母乳喂养指导手册》是“专科护理临床实用指导”系列丛书之一,是一本由中华护理学会第25届妇产科护理专业委员会组织全国妇产科护理专家编写的实用性很强的辅助教材。
母乳喂养关系到母婴的健康,是产科护理的重要工作之一。我国现有7000多所爱婴医院,设立爱婴医院的目的是保护、支持、促进母乳喂养。产科的医护人员很需要母乳喂养这方面的专业知识指导,但是目前国内此类指导书还很少。因此,针对这一现状和需求,我们编写了《母乳喂养指导手册》。
本书详细介绍了爱婴医院和母乳喂养的相关政策、母乳喂养的重要性、母乳喂养技巧、特殊情况下的母乳喂养及有关母乳喂养常见问题的解答。内容科学,图文并茂,不仅可为临床护士提供切实可行的指导,对于不断提高我国纯母乳喂养率、促进儿童健康成长也有十分重要的意义。
参加本书编写工作的专家均来自临床一线,有着多年丰富的母乳喂养指导和教学经验,其中部分专家还参加过世界卫生组织的培训。
本书在编写的过程中得到了美德乐(北京)医疗科技有限公司的支持与帮助,在此表示感谢!
由于编者的水平有限,疏漏之处在所难免,恳请广大读者提出宝贵建议和意见,以便不断改进。

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Gift card deals are special offers for selected products;

The gift card deals will automatically be activated if a customer uses gift card balance at check out and the balance is sufficient to pay for the total price of the shopping cart products with gift card deals;

You will not be able to activate the gift card deals if you choose other payment methods besides gift card. The products will be purchased at their normal prices;

If your account balance is not enough to pay for the products with gift card deals, you can choose to reload your gift card balance by clicking on the Reload button at either shopping cart page or check out page;

Products that have gift card deals can be recognized by a special symbol showing 'GC Deal';

For any additional questions or concerns, please contact our customer service;

Yamibuy reserves the right of final interpretation.

Sold by Yami

Service Guarantee

Yami Free Shipping over $49
Yami Easy Returns
Yami Ships from United States

Shipping

  • United States

    Standard Shipping is $5.99 (Excluding Alaska & Hawaii). Free on orders of $49 or more.

    Local Express is $5.99 (Available in Parts of CA, NJ, MA & PA). Free on orders of $49 or more.

    2-Day Express (Includes Alaska & Hawaii) starts at $19.99.

Return Policy

Yami is committed to provide our customers with a peace of mind when purchasing from us. Most items shipped from Yamibuy.com can be returned within 30 days of receipt of shipment (For Food, Beverages, Snacks, Dry Goods, Health supplements, Fresh Grocery and Perishables Goods, within 7 days of receipt of shipment due to damages or quality issues; To ensure that every customer receives safe and high-quality products, we do not provide refunds or returns for beauty products once they have been opened or used, except in the case of quality issues; Some products may have different policies or requirements associated with them, please see below for products under special categories, or contact Yami Customer Service for further assistance).
Thank you for your understanding and support.

Learn More

Sold by Yami

Terms and Conditions of Yami E-Gift Card

If you choose “Redeem automatically” as your delivery method, your gift card balance will be reload automatically after your order has been processed successfully;

If you choose “Send to Email”as your delivery method, the card number and CVV will be sent to the email address automatically;

Any user can use the card number and CVV to redeem the gift card, please keep your gift card information safely. If you have any trouble receiving email, please contact Yami customer service;

Yami gift card can be used to purchase both Yami owned or Marketplace products;

Yami gift card will never expire;

Yami gift card balance does not have to be used up at once;

All rights reserved by Yami.

Return Policy

Gift card that has already been consumed is non-refundable.

Sold by JD@CHINA

Service Guarantee

Yami Free Shipping over $49
Yami Easy Returns
Yami Ships from United States

Shipping

  • United States

    Standard Shipping is $5.99 (Excluding Alaska & Hawaii). Free on orders of $49 or more.

    Local Express is $5.99 (Available in Parts of CA, NJ, MA & PA). Free on orders of $49 or more.

    2-Day Express (Includes Alaska & Hawaii) starts at $19.99.

Return Policy

You may return product within 30 days upon receiving the product. Items returned must be new in it's original packing, including the original invoice for the purchase. Customer return product at their own expense.

Sold by JD@CHINA

Service Guarantee

Yami Cross-store Free Shipping over $69
Yami 30-days Return

Yami-China FC

Yami has a consolidation warehouse in China which collects multiple sellers’ packages and combines to one order. Our Yami consolidation warehouse will directly ship the packages to your door. Cross-store free shipping over $69.

Return Policy

You may return products within 30 days upon receiving the products. Sellers take responsibilities for any wrong shipment or missing items. Packing needs to be unopened for any other than quality issues return. We promise to pack carefully, but because goods are taking long journey to destinations, simple damages to packaging may occur. Any damages not causing internal goods quality problems are not allowed to return. If you open the package and any quality problem is found, please contact customer service within three days after receipt of goods.

Shipping Information

Yami Consolidation Service Shipping Fee $9.99(Free shipping over $69)

Sellers in China will ship their orders within 1-2 business days once the order is placed. Packages are sent to our consolidation warehouse in China and combined there. Our Yami consolidation warehouse will directly ship the packages to you via UPS. The average time for UPS to ship from China to the United States is about 10 working days and it can be traced using the tracking number. Due to the pandemic, the delivery time may be delayed by about 5 days. The package needs to be signed by the guest. If the receipt is not signed, the customer shall bear the risk of loss of the package.

Sold by JD@CHINA

Service Guarantee

Free shipping over 69
Genuine guarantee

Shipping

Yami Consolidated Shipping $9.99(Free shipping over $69)


Seller will ship the orders within 1-2 business days. The logistics time limit is expected to be 7-15 working days. In case of customs clearance, the delivery time will be extended by 3-7 days. The final receipt date is subject to the information of the postal company.

Yami Points information

All items are excluding from any promotion or points events on Yamibuy.com

Return Policy

You may return product within 30 days upon receiving the product. Items returned must be new in it's original packing, including the original invoice for the purchase. Customer return product at their own expense.

Yami

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Jingdong book

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Jingdong book